US5578046A - Composite bioabsorbable materials and surgical articles made thereform - Google Patents

Abstract

The present invention relates to composite materials having a core portion formed from a first bioabsorbable material and at least one shell portion of a second bioabsorbable material joined to the core portion. The first and second bioabsorbable materials have different rates of bioabsorption. In a preferred embodiment, the core portion is coextruded with the shell portion to form a composite filament or sheet. The materials of the present invention may be used as sutures or formed into medical devices or surgical articles for implantation within a living organism.

Description

This is a divisional of U.S. application Ser. No. 08/194,766 filed Feb. 10, 1994.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to bioabsorbable materials and, more particularly, to composite bioabsorbable materials such as filaments and sheets. The composite includes a core of a first bioabsorbable material and at least one shell joined to the core, the shell being formed of a second bioabsorbable material. The first and second bioabsorbable materials preferably have different absorption rates.

2. Description of the Related Art

Bioabsorbable materials are known in the art for a variety of uses, particularly those uses in which the bioabsorbable material is implanted within a living organism for medical purposes. The term "bioabsorbable" is used to describe a material capable of being broken down into smaller constituents which can be metabolized and/or excreted by a living organism. Hydrolysis is one mechanism by which many bioabsorbable materials are broken down following implantation within a living organism. Such materials are useful for temporarily holding tissues in a desired position during healing, and being absorbed by the organism after a period of time.

Various bioabsorbable materials and medical devices made therefrom are known in the art. See, e.g., U.S. Pat. Nos. 2,668,162; 2,703,316; 2,758,987; 3,225,766; 3,297,033; 3,422,181; 3,531,561; 3,565,077; 3,565,869; 3,620,218; 3,626,948; 3,636,956; 3,736,646; 3,772,420; 3,773,919; 3,792,010; 3,797,499; 3,839,297; 3,867,190; 3,878,284; 3,982,543; 4,047,533; 4,052,988; 4,060,089; 4,137,921; 4,157,437; 4,234,775; 4,237,920; 4,300,565; 4,429,080; 4,441,496; 4,523,591; 4,546,152; 4,559,945; 4,643,191; 4,646,741; 4,653,497; and, 4,741,337; U.K. Patent No. 779,291; D. K. Gilding et al., "Biodegradable polymers for use in surgery polyglycolide/poly(lactic acid) homo- and copolymers: 1", Polymer, Volume 20, pages 1459-1464 (1979), and D. F. Williams (ed.), Biocompatibility of Clinical Implant Materials, Vol, II, ch. 9: "Biodegradable Polymers" (1981).

Fiber-reinforced compositions used for surgical implants have been described in U.S. Pat. Nos. 4,279,249; 4,550,449; 4,539,931; 4,743,257; 5,080,665. The fiber-reinforcements in these compositions provide increased strength and rigidity as may be required for bone repair, but render these compositions unsuitable where flexibility is required.

The present invention provides an implantable composite having a bioabsorption rate which varies over time and which is suitable for use in making a variety of medical devices, including those in which flexibility is a desirable characteristic.

SUMMARY OF THE INVENTION

The present invention relates to composite materials having a core portion formed from a first bioabsorbable material and at least one shell portion formed from a second bioabsorbable material joined to the core portion. The first and second bioabsorbable materials have different rates of bioabsorption. In a preferred embodiment, the core portion is coextruded with the shell portion to form a composite filament or sheet. The materials of the present invention may be used as sutures or formed into medical devices or surgical articles for implantation within a living organism.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates a filament having a core portion and a shell portion according to the present invention.

FIG. 1B illustrates a filament having a core portion and plural shell portions according to the present invention.

FIG. 2A illustrates a sheet having a core portion and a shell portion according to the present invention.

FIG. 2B illustrates a sheet having a core portion and plural shell portions according to the present invention.

FIG. 3 is a coextrusion die optionally used to form a composite filament according to the present invention.

FIG. 4 is a coextrusion die optionally used to form a composite sheet according to the present invention.

FIG. 5 schematically illustrates a spinning process used to form filaments according to the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now in detail to the drawings, FIG. 1A shows afilament 10 having a core portion 20 surrounded by ashell portion 30.Shell portion 30 is joined to core portion 20 in such a manner that the two portions form a single, structural element, i.e.,filament 10. As such,filament 10 is a composite material in which all of the constituent elements contribute to the properties of the overall structure. Thus,filament 10 differs from coated filaments in that the coatings of such filaments, even for very thick coatings, do not contribute substantially to the strength of the filament.

FIG. 1B illustrates acomposite filament 15 having acore portion 25, afirst shell portion 35, and a second shell portion 38. In this embodiment, three separate materials may be used to formportions 25, 35, and 38 or the outer shell 38 may be the same material as thecore portion 25. It is within the scope of the invention to produce filaments having any number of shell portions, depending upon the desired application of the filament.

FIG. 2A shows acomposite sheet 40 having acore portion 50 and ashell portion 60. As with the composite filament of FIG. 1, thecomposite sheet 40 is fabricated so that thecore 50 is joined toshell 60 such that the sheet behaves as a unified structural entity.

FIG. 2B shows acomposite sheet 45 having acore portion 55 andshell portions 65 and 75. As with the composite filament of FIG. 1B, the sheet of FIG. 2B may include any number of shell portions, depending upon its ultimate use.

The dimensions of the core portion and shell portion can vary widely depending on a number of factors including the materials from which the composite is made and the intended use of the composite. Generally, the thickness of the core portion can range from about 0.001 mm to 10 mm or more, and the thickness of the shell portion can range from about 0.0001 mm to about 10 mm or more. For example, when the intended use is as a suture, a composite having a generally cylindrical core portion made from polydioxanone with a diameter in the range of about 0.01 mm to about 0.8 mm, with a shell portion made from polycaprolactone having a thickness of about 0.001 mm to about 0.5 mm will provide a filament having acceptable flexibility and strength. Where a more rigid, rod-like structure is desired, for example to be used as an osteosynthesis device, a generally cylindrical core portion made from polyglycolide with a diameter in the range of about 0.1 mm to about 1.0 mm with a shell portion made from polydiaxanone and having a thickness of about 0.001 mm to about 0.2 mm will provide suitable rigidity and strength. For laminated sheet-like composites, useful for example as an adhesion barrier, hernia repair device, organ support, artificial skin substrate, bone plate, or stent, a core portion made from polyglycolide having a thickness of about 0.0 mm to about 5 mm having a shell portion made from polydioxanone and having a thickness of about 0.01 mm to about 0.25 mm joined to at least one side of the core portion would provide a composite with suitable physical characteristics.

In particularly useful embodiments, the core portion and shell portion are substantially co-extensive. It is also contemplated, however, that composites wherein the shell portion only partially covers the core portion can be made in accordance with this invention.

In a preferred embodiment, the materials used to form the core and shell portions ofcomposite filament 10 andcomposite sheet 40 are bioabsorbable materials. Bioabsorbable materials used to form the core portions of these composites include, but are not limited to absorbable polymers made from glycolide, glycolic acid, lactide, lactic acid, caprolactone, dioxanone, trimethylene carbonate and dimethyl trimethylene carbonate. Copolymers (block or random) and mixtures and blends of such polymers or copolymers are also useful. Particularly useful absorbable polymers for the core portion include glycolide/lactide copolymers, polycaprolactone and polydioxanone.

Bioabsorbable materials used to form the shell portions of the composite filaments and sheets include, but are not limited to, absorbable polymers made from glycolide, glycolic acid, lactide, lactic acid, caprolactone, dioxanone, trimethylene carbonate and dimethyl trimethylene carbonate. Copolymers, (block or random) and mixtures and blends of such polymers and/or copolymers are also useful. Particularly useful polymers for the shell portion include polydioxanone, polycaprolactone, polylactide and polytrimethylene carbonate.

In one preferred embodiment of the present invention, the material used to form the core portion of the composite material has a higher rate of bioabsorption than the material used to form the shell portion of the composite material. This embodiment provides a strong, fiber-forming core material combined with a flexible shell material to provide a strong and flexible composite. Such core materials include, but are not limited bioabsorbable polymers, copolymers, or mixtures fabricated from glycolide or glycolic acid. Particularly preferred glycolidecontaining polymers include copolymers of glycolide and lactide having 90% glycolide and 10% lactide, copolymers of glycolide and lactide having 92.5% glycolide and 7.5% lactide, and copolymers of glycolide and lactide having 18% glycolide and 82% lactide.

Materials having a lower rate of hydrolysis relative to the above glycolide-containing polymers are used to form the shell portion of the above composite material. Such relatively lower hydrolysis rate materials include bioabsorbable polymers, copolymers, or mixtures fabricated from polydioxanone, polyactide, polycaprolactcne, and polytrimethylene carbonate.

Particularly preferred combinations for composite materials having a core with a higher rate of hydrolysis than the shell include, but are not limited to: a core of a copolymer of 18% glycolide and 82% lactide with a shell of polydioxanone; a core of a copolymer of 92.5% glycolide and 7.5% lactide with a shell of polydioxanone; a core of a copolymer of 25% glycolide and 75% lactide backfilled with glycolide as shown in U.S. Pat. No. 4,844,854 with a shell of polydioxanone; a core of a triblock copolymer glycolide and dioxanone (as described above) with a shell of polycaprolactone; and a core of polydioxanone with a shell of polycaprolactone.

In another preferred embodiment of the present invention the material used to form the core portion of the composite material has a lower rate of bioabsorption than the material used to form the shell portion of the composite material. A higher rate of bioabsorption for the shell may, in some applications, serve to enhance tissue ingrowth and subsequent healing and wound closure. In this embodiment, the core may be of bioabsorbable polymers, copolymers, or mixtures fabricated from polydioxanone, polycaprolactone, and polytrimethylene carbonate. The shell may be of bioabsorbable polymers, copolymers, or mixtures fabricated from glycolide or glycolic acid. Particularly preferred glycolide-containing polymers include copolymers of glycolide and lactide having 90% glycolide and 10% lactide, copolymers of glycolide and lactide having 92.5% glycolide and 7.5% lactide, and copolymers of glycolide and lactide having 18% glycolide and 82% lactide.

The invention also contemplates using materials that are formed from the same composition for both the core and the shell portions. However, the morphology of the material of the core layer is selected to be different from the morphology of the material of the shell layer such that the two layers have different rates of bioabsorption. In general, it is known that amorphous polymers have higher rates of hydrolysis than crystalline versions of the same polymer. For example, the core material may be formed from an amorphous glycolide-containing polymer while the shell may be formed from a crystalline glycolide-containing polymer. Materials may be added to the polymer melt during formation of the composite material to promote crystallinity in the shell layer.

Although the above descriptions of preferred embodiments focus on bioabsorbable polymers, it is understood that those of skill may select any two bioabsorbable materials having different rates of bioabsorption to construct a bioabsorbable composite having the desired strength and bioabsorption characteristics needed for a particular medical or surgical application. Such bioabsorbable materials include, but are not limited to, collagen, chitin, chitin derivatives (e.g., chitosan), amino acid polymers (e.g., gelatin), and polysaccharides (e.g., dextran).

In another aspect of the present invention, composite materials having a core/shell structure may be fabricated using non-absorbable, biocompatible materials. Such materials include biocompatible polymeric materials which may be used in applications requiring a more permanent implantation of a prosthetic device. Core and shell polymeric materials include polyesters (e.g., polyalkyl terephthalates), polyamides (e.g., nylon), polyurethanes, polycarbonates, polyimides, fluoropolymers, polyolefins, vinyl polymers, etc.

Particularly preferred combinations include coextruded polyester and polyurethane fibers and coextruded low order and high order nylons such as nylon 6 or nylon 66 with nylon 12. Biocompatible implants such as sutures, soft tissue patches, surgical mesh, wound dressings, surgical felts, vascular grafts, nerve repair devices, artificial skin and sternum tape may be fabricated from the composite biocompatible materials.

The composite filaments and sheets of the present invention may be fabricated by a number of known polymer processing techniques. One preferred technique is coextrusion. Extrusion is a polymer processing technique in which a viscous melt is fed, under pressure, through a die in a continuous stream. In coextrusion, plural polymer melt streams feed through individual flow channels to be shaped as a single polymeric article. The polymer melts may be combined in several ways. Plural melts may be extruded separately from a single die, plural melts may be extruded partly separately followed by combined extrusion, or plural melts may be coextruded together.

A coextrusion die which may be used to form a composite filament according to the present invention is illustrated schematically in FIG. 3. In FIG. 3, the polymer melt used to form core 20 offilament 10 passes throughcentral flow channel 70 where it is shaped as it passes throughchannel exit 72. The polymer melt used to form theshell 30 offilament 10 passes throughouter flow channel 80 where it is shaped as it passes throughchannel exit 82. The two concentric polymer melts are joined atdie exit 90, forming a continuous polymer melt.

A coextrusion die which may be used to form a composite sheet according to the present invention is schematically depicted in FIG. 4. In FIG. 4, the polymer used to formcore portion 50 ofsheet 40 is fed from an extruder to flowchannel 100. The polymer used to formshell portion 60 ofsheet 40 is fed from extruders to flowchannels 110 and 120. The melts are inregion 130 of the die and are formed into a sheet inregion 140.

The dies and methods described above with reference to FIGS. 3 and 4 are exemplary of coextrusion techniques used to form the filaments and sheets of the present invention. Any coextrusion process may be used to form the bioabsorbable composite filaments and sheets. Examples of other coextrusion processes suitable for use in forming the materials of the invention as well as examples of suitable extrusion apparatus which may be used with the dies of FIGS. 3 and 4 are found in Vols. 4 and 6 of the Encyclopedia of Polymer Science and Engineering, (John Wiley & Sons, New York), c. 1986, pp. 812-832 and 571-631, respectively, which are incorporated by reference herein.

In another preferred embodiment of the present invention, the composite materials may be spun into fibers to be used as monofilament or multifilament sutures. An exemplary spinning process is schematically illustrated in FIG. 5. To produce fibers having the core/shell structure of FIG. 1, the core and shell constituent materials are separately melted. The constituent materials are separately fed as polymer melts 213 tospinneret 215 and are combined in the manner shown in FIG. 3 just before the spinneret exit orifice. Although a single filament is shown for clarity in FIG. 5, it is understood that spinnerets having any desired number of exit orifices in a range of exit diameters may be used.

Molten monofilament 216 exits spinneret 215, passes throughair gap 214, and enters quenchbath 217.Air gap 214 is the distance between the spinneret exit andbath 217. Preferably, the air gap distance ranges from 0.5 to 100 centimeters and, more preferably, from about 1 to 20 centimeters. Asmonofilament 216 passes through bath 21, it solidifies. In a preferred embodiment, quenchbath 217 is a water bath.

within the quench bath,filament 216 is driven bydrive roller 218. As it emerges from the bath, a wiper may optionally remove excess water.Monofilament 216 wraps around afirst godet 221 and is prevented from slipping by niproll 222.Godets 301, 302, 303, and 304 engage and drive the filament prior to a stretching operation. The number of godets is not critical; any suitable godet system may be employed in the spinning process of the present invention.

During stretching,monofilament 216 is drawn throughhot water bath 223 bygodets 224, 305, 306, 307, and 308 or any other suitable arrangement. This second godet system rotates at a higher speed than that of godet 104 to provide a desired stretch ratio.

Following stretching,monofilament 216 may be annealed within hotair oven chamber 225, driven bygodets 226, 309, 310, 311, or 312, or any other suitable drawing system. Take-up reel 313 winds the finished monofilament product.

Other suitable fiber manufacture processes, including other spinning processes, which may be used to form the composite materials of the present invention are described in Volume 6 of the Encyclopedia of Polymer Science and Engineering, (John Wiley & Sons, New York), c. 1986, pp. 802-839, the disclosure of which is incorporated by reference herein.

Other polymer processing techniques may be used to form the composite filaments and sheets of the present invention. These include, but are not limited to, casting, injection molding, and blow molding. In short, any polymer processing technique capable of creating composite materials having shell portions adequately joined with core portions are contemplated to form the composite bioabsorbable materials of the present invention.

In general, the formation of a composite depends on both materials being heated to a temperature at which fusion of at least the surface of the materials begins. Where coextrusion is the method used to from the composite, both materials are heated to a temperature above their respective melting points. Where pressing is used to from the composites, the combination of temperature and pressure should be such that at least the surface of the core portion and the surface of the shell portion in contact therewith begin to fuse so that the two portions are joined into a unitary structure.

As will be appreciated by those skilled in the art, a certain amount of mixing of the core and shell materials will occur at the interface of those two portions. The amount of mixing may be only at the molecular level and thus, as a practical matter undetectable. However, in some instances the amount of mixing may be sufficient to produce a micro-shell layer at the interface between the shell and core portions. This micro-shell layer is made from a mixture of the core and shell materials and has its own bioabsorption profile.

The composite bioabsorbable materials of the present invention may be used to form various surgical devices. The composite filaments may be used as monofilament sutures or combined to make multifilament sutures. The filaments may be woven to form sheets which may be used to form various prosthetic devices such as vascular grafts, muscle grafts, bone fillers, etc. Alternatively the filaments can be formed into non-woven fabrics by lamination with or without additional polymeric matrix. Such non-woven fabrics may be used for the same purposes as the woven fabrics listed above.

The composite bioabsorbable sheets of the present invention may also be used to form prosthetic devices. Devices may be formed by molding the composite sheets into the above named devices. The sheets may also be formed into other surgical implants such as surgical clips, surgical fasteners, staples, bone pins, bone screws, anastomosis rings, wound dressings, drug delivery devices, etc.

It is within the scope of this invention to coat or impregnate the bioabsorbable composite materials of the present invention as well as implants and prosthetic devices made therefrom with one or more materials which enhance its functionality, e.g., surgically useful substances, such as those which accelerate or beneficially modify the healing process when the material is implanted within a living organism. Thus, for example, antimicrobial agents such as broad spectrum antibiotics (gentamicin sulphate, erythromycin or derivatized glycopeptides) which are slowly released into the tissue can be incorporated to aid in combating clinical and sub-clinical infections in a surgical or trauma wound site.

To promote wound repair and/or tissue growth one or several substances can be introduced into the composite bioabsorbable materials of the present invention or impregnated into fabrics or prostheses made from the composite bioabsorbable materials. Exemplary substances include polypeptides such as human growth factors. The term "human growth factor" or "HGF" embraces those materials, known in the literature, which are referred to as such and includes their biologically active, closely related derivatives. The HGFs can be derived from naturally occurring sources and are preferably produced by recombinant DNA techniques. Specifically, any of the HGFs which are mitogenically active and as such effective in stimulating, accelerating, potentiating or otherwise enhancing the wound healing process are useful herein. Growth factors contemplated for use in the materials of the present invention include hEGF (urogastrone), TGF-beta, IGF, PDGF, FGF, etc. These growth factors, methods by which they can be obtained and methods and compositions featuring their use to enhance wound healing are variously disclosed, inter alia, in U.S. Pat. Nos. 3,883,497; 3,917,824; 3,948,875; 4,338,397; 4,418,691; 4,528,186, 4,621,052; 4,743,679 and 4,717,717; European Patent Applications 0 046 039; 0 128 733; 0 131 868; 0 136 490; 0 147 178; 0 150 572; 0 177 915 and 0 267 015; PCT International Applications WO 83/04030; WO 85/00369; WO 85/01284 and WO 86/02271 and UK Patent Applications GB 2 092 155 A; 2,162,851 A and GB 2 172 890 A, all of which are incorporated by reference herein. When incorporating wound healing substances such as those discussed above, it may be advantageous to use composite materials having at least one shell layer are formed from a bioabsorbable material having a relatively high rate of bioabsorption. By incorporating wound healing substances in a high rate bioabsorption layer, the substance will be more quickly absorbed while the remaining composite material will still retain sufficiently good mechanical properties to perform its medicaid or surgical function.

To decrease abrasion, increase lubricity, etc., the bioabsorbable composite materials can be coated with various substances. Copolymers of glycolide and lactide and polyethylene oxide, calcium salts such as calcium stearate, compounds of the pluronic class, copolymers of caprolactone, caprolactone with PEO, polyHEMA, etc. may be employed.

Table I below sets forth typical conditions for extruding, stretching composite monofilament sutures in accordance with this invention.

              TABLE I                                                     ______________________________________                                    CONDITIONS OF MANUFACTURING COMPOSITE                                     MONOFILAMENT OF THE PRESENT INVENTION                                                    EXAMPLE                                                    Suture Size    3/0                                                        Material       Polycaprolactone                                                                       Polydioxanone                                 ______________________________________                                    Process Conditions                                                                       Extrusion Operation                                        ______________________________________                                    Extruder       Extruder 1 (shell)                                                                     Extruder 2 (core)                             extruder screw, rpm                                                                      0.6          1.3                                           pump rpm       4.4          5.8                                           barrel temp., °C.,zone A                                                         80           52                                            barrel temp., °C.,zone B                                                         120          135                                           barrel temp., °C.,zone C                                                         120          135                                           clamp temp., °C.                                                                  120          135                                           adapter temp., °C.                                                                120          130                                           ______________________________________                                    Process Conditions                                                                       Extrusion Operation                                        ______________________________________                                    pump temp., °C.                                                                   120          135                                           barrel melt temp., °C.                                                            117          149                                           pump melt temp., °C.                                                              117          150                                           spinneret melt temp., °C.                                                         118          118                                           barrel pressure, psi                                                                     760          1250                                          pump pressure, psi                                                                       500          1000                                          spinneret pressure, psi                                                                  840          1980                                          pump size, cc per                                                                        0.16         0.16                                          revolution                                                                outside diameter of                                                                      0.28         --                                            spinneret orifices, mm                                                    inside diameter of                                                                       --           0.25                                          spinneret orifices, mm                                                    quench bath temp., °C.                                                            18           18                                            ______________________________________                                                  Stretching (Orienting) Operation                                          EXAMPLE                                                     ______________________________________                                    draw bath temp., °C.                                                               50                                                        first godet, mpm                                                                          4.2                                                       second godet, mpm                                                                         19.7                                                      second oven temp., °C.                                                             70                                                        third godet, mpm                                                                          24.6                                                      draw ratio      5.9:1                                                     ______________________________________                                                  Annealing Operation                                                       EXAMPLE                                                     ______________________________________                                    oven temp., °C.                                                                    50                                                        time (hrs.)     18                                                        ______________________________________

The physical properties of the sutures and the procedures employed for their measurement are set forth in Table II as follows:

              TABLE II                                                    ______________________________________                                    PROCEDURES FOR MEASURING PHYSICAL                                         PROPERTIES OF COMPOSITE MONOFILAMENT                                      SUTURES OF THE PRESENT INVENTION                                          Physical Property                                                                       Test Procedure                                              ______________________________________                                    knot-pull strength, kg                                                                  U.S.P. XXI, tensile strength,                                             sutures (881)                                               straight-pull strength, kg                                                              ASTM D-2256, Instron Corporation                            elongation, % ASTM D-2256                                                 tensile strength, kg/mm.sup.2                                                           ASTM D-2256, Instron Corporation                                          Series IX Automated Materials                                             Testing System 1.03A                                        ______________________________________

Table III below sets forth the physical properties of the composite monofilament suture of the present invention.

              TABLE III                                                   ______________________________________                                    Physical Property                                                         ______________________________________                                    diameter (mm)           0.295                                             shell thickness (mm)    0.036                                             core thickness (mm)     0.223                                             knot-pull strength (kg) 2.2                                               straight-pull strength (kg)                                                                       3.0                                               elongation (%)          26                                                tensile strength (kg/mm.sup.2)                                                                    47                                                ______________________________________

Although the composite bioabsorbable materials and processes for their manufacture have been described in terms of the preferred embodiments, numerous modifications will be readily apparent to those skilled in the art. For example, composite medical or surgical articles having a composite core/shell structure may be formed directly by coextrusion, injection molding, casting, etc. Composite materials having a core/shell structure may also be fabricated by lamination bonding techniques, e.g., hot isostatic pressing. Such techniques also result in composite materials whose mechanical properties may be described using the above rule of mixtures equation.

While the invention has been shown and described with reference to the preferred embodiments, it will be understood by those skilled in the art that various modifications in form and detail may be made without departing from the scope and spirit of the invention. Accordingly, modifications such as those suggested above, but not limited thereto, are to be considered within the scope of the invention.

Claims (4)

What is claimed is:

1. A composite bioabsorbable sheet implantable within a living organism comprising:

a core portion formed from a first bioabsorbable material;

a shell portion substantially coextensive with and substantially surrounding said core portion to form a composite sheet, said shell portion formed from a second bioabsorbable material;

said first and second bioabsorbable materials having different rates of bioabsorption.

2. A bioabsorbable sheet as recited in claim 1 wherein said first bioabsorbable material has a greater rate of bioabsorption than said second bioabsorbable material.

3. A bioabsorbable sheet as recited in claim 1 wherein said first and second bioabsorbable materials are selected from polymers, copolymers, block copolymers, and mixtures and blends of polymers, copolymers, and block copolymers of glycolide, glycolic acid, lactide, lactic acid, caprolactone, dioxanone, trimethylene carbonate, dimethyl trimethylene carbonate, 1,3 dioxane-2-one, and 1,4 dioxane-2-one.

4. A bioabsorbable sheet comprising:

a core portion formed from a first bioabsorbable material;

a shell portion joined to said core portion, said shell portion formed from a second bioabsorbable material;

said first and second bioabsorbable materials having different rates of bioabsorption, wherein said shell portion comprises a first shell portion formed from said second bioabsorbable material and a second shell portion formed from a third bioabsorbable material, said second and third bioabsorbable materials having different rates of bioabsorption.

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